Evaluation of the efficacy of intervention in the management of AD chronic disease based on the theory of “prevention of the recrudescence of disease”

1.Introduction

Atopic dermatitis (AD) is a common inflammatory skin disease with a chronic course and a high recurrence rate, and the main clinical symptoms are recurrent skin lesions and severe itching [1]. Current studies reveal that the occurrence of AD is related to genetic, immune, psychiatric, and environmental factors, and often begins in infancy and childhood [2], which has a serious impact on the life quality of patients and their family members. The cause of AD is chronic and persistent, and the treatment and management of AD is internationally recognized as “step grading treatment”. First, the patients are informed and managed. Only when the skin is dry, emollients and moisturizers are used to maintain skin moisturization. For stubborn and severe patients, systematic treatment is adopted, and the immune mechanism is the TCM mechanism of AD pathogenesis, the incidence and recurrence rate are high, and there is still a lack of specific drugs, which has become a hot spot in clinical research in recent years, and the goal of AD research is to establish a long-term management plan and to reduce its recurrence [3].

The theory is based on the idea of “Prevention of the recrudescence of disease”, and in accordance with the basic principle of “regulation as the main and treatment as the supplement” [4], after the initial recovery of some diseases, appropriate conditioning and maintenance methods or health care methods are adopted to restore the body’s internal organ function, qi, blood and fluid, thereby promoting the body to restore a healthy state and prevent the recurrence of the disease [5]. That is, when a person is recovering from a certain disease, it is recommended to continue to regulate the healthy qi, eliminate residual evil, and be cautious against triggers, so as to achieve “prevention and recovery after illness”. This theory complements the Western medicine theory of “chronic disease managemen”. Chronic disease management is to provide continuous medical support for patients with chronic diseases in the clinic [6], in addition to drug guidance, index detection, including medical knowledge, concepts, nursing and other related soft support. It has been used in the management of a variety of chronic diseases, and has achieved better control of the disease and delayed the recurrence effect, such as common chronic obstructive pulmonary disease and chronic kidney disease [7, 8]. Prior studies show that the 7-year recurrence rate of AD patients is as high as 75.9%, which is the first skin disease burden among non-fatal diseases. Based on this, in October 2022, China’s first <Atopic Dermatitis Full Name Management Consensus> was officially released, this <Consensus> will fill the gap in the management of the whole course of moderate and severe atopic dermatitis patients, and ultimately achieve the purpose of improving the current status of treatment, reducing AD recurrence and reducing the burden of this disease. The application of traditional Chinese medicine (TCM) has clear efficacy and high safety in the treatment of AD and the reduction of recurrence [9]. Since 2019, based on the theory of “prevention of the recrudescence of disease”, we have combined the application of the experience of Dr Chen Ninggang, the director of Yongpai’s famous TCM practitioner, in the management of chronic diseases in the stable stage of patients with spleen deficiency and wet AD. The results have been obvious with the review and analysis report as follows.

2.Clinical data

3.Intervention methods

4.Compute evaluation indicators

Relapse (IGA > 2) was recorded in both groups, including the number of relapses, the time of the first recurrence (between the start of the study and the first recurrence), and the duration of the relapse.

Apply the Eczema Area and Severity Index (EASI) to assess the severity of the patient’s recurrence. Visual Analogue Score (VAS) was applied to evaluate the patient’s itching at the time of recurrence. VAS: a horizontal line about 10-centimetre long is drawn on a piece of blank paper, the leftmost end represents 0 points, and the rightmost end represents 10 points. According to his/her own itchiness, the patient marks in the horizontal line, and the reading according to the mark location is then the VAS score. The higher the score represents the more severe the itching. Dermatology Life Quality Index (DLQI) scores were used to evaluate the life quality in both groups. That is, using the DLQI scale, a total of 10 questions with a retrospective evaluation of the life quality related to skin diseases in the past one week were asked, and the total scores of each question is added together with a maximum of 30 points. The higher the total score value, the worse the quality of life. The observation period is 3 months.

5.Statistical analysis

The SPSS 22.0 statistical software was used for the analysis. The count data was expressed as a rate (%), and a χ2 test was performed. Measurement data that conform to the normal distribution are represented by (x (_) ± s), with t-test; Dose data for non-normal sutures are expressed as [M (Q25, Q75)], ranked and tested. P< 0.05 is statistically significant.

6.Results

6.2Comparison of the severity, itching and life quality of the two groups of patients at the time of recurrence

Results are reported in Fig. 1. The EASI score, VAS score of itching, and DLQI score in the research group were significantly lower than those in the control group at the time of recurrence, and the differences were statistically significant (P< 0.01).

Figure 1.

Column 1 represents the research group and column 2 represents the control group, P< 0.01.

7.Discussion

As a chronic recurrent inflammatory skin disease [1], AD has a wide range of age groups, high prevalence and recurrence rate. Prior studies have shown that the recurrence rate of AD is as high as 70%, and the life quality of AD patients and their families is worrying, with heavy economic burden. At present, the treatment of AD includes topical calcineurin inhibitors, glucocorticoids, phototherapy, oral antihistamines, oral immunosuppressants, injectable biological agents, etc. [12, 13, 14, 15]. However, the existence of problems such as easy repetition, poor safety for long-term use, and heavy economic burden limit the prevention and treatment of AD by current methods. In the past two years, although dupilumab and JAK inhibitors have been frequently used with considerable efficacy, the actual research data still need to be further accumulated and summarized [16, 17]. Therefore, in view of the course and characteristics of AD, its full-process management has gradually received the attention from the public [18], and it is especially important to use safe and effective methods to prolong the long-term efficacy of patients and reduce the recurrence of the disease. In the management of chronic diseases in AD, patient health education and avoidance of predisposing factors have been widely recognized by the population. At present, studies have shown that AD patients in remission still have certain subclinical inflammatory reactions in the body, and there is lymphocyte infiltration in local tissues, coupled with strong affinity of inflammatory factors in the body, so AD patients are prone to recurrent inflammatory reactions [18, 19], resulting in their repetition with difficulty to heal. It is speculated that in the management of chronic diseases in AD, the use of safe and effective drugs to control the subclinical inflammatory response in the body, or the reduction of the affinity of inflammatory factors in the patient’s body can effectively inhibit the recurrence of AD. In recent years, the efficacy of TCM in the treatment of atopic dermatitis is precise and the advantages are obvious.

The summarization of the etiology and pathogenesis of AD has been prevelent to ample doctors since ancient times. Some scholars have carried out certain statistics on ancient books and literature related to AD, and results show that within 71 studies, 48 described 7 etiology and pathogenesis, which are mainly caused by wind, dampness and heat, but also by fetal toxic heat, excessive heart fire, blood dryness, spleen deficiency, eating disorders, etc. According to the characteristics of modern life, recent doctors start to believe that the onset of AD is closely related to the function of the spleen and stomach, and spleen deficiency and dampness is the core pathogenesis of the disease. Director Chen Ninggang, a famous Chinese medicine practitioner in our hospital, pays attention to the long-term management of diseases during his consultation. In the treatment of inflammatory skin diseases, he advocated that “to treat the skin, it is first to treat the spleen”. The spleen and stomach are the foundation in the daily life. If the body’s spleen and stomach are deficient, and the source of qi and blood biochemistry is then lacking, it is therefore easy to induce all diseases. If the spleen is healthy, the qi and blood are biochemically active with abundant qi, the evil cannot be done. Combined with the theory of “Prevention of the recrudescence of disease” in the treatment of pre-existing diseases by TCM, after the initial clinical recovery of AD, the method of harmonizing the function of the spleen and stomach of the medium focus is adopted to promote the body function of internal organs to restore a healthy state and prevent the recurrence of the disease. “Compound ginseng cicada soup” is tailored from the Jingfang of “Sen Ling Bai Shu San”, which is the clinical experience of Director Chen Ninggang. Fang Zhongjun medicine is party ginseng, which is used to strengthen the spleen and qi to solidify the foundation. Cicada clothes are used to dispel wind and relieve itching, and the medicine baishu, poria, yam, lentils, and coix renxing are used to strengthen the qi and consolidate the surface, with dispelled wind and relieved itching. All these are supplemented by Guya, and chicken Neijin to strengthen the spleen and stomach. Jujube and licorice are also used as a medicine to neutralize and harmonize other medicines. All the medicines play a role in strengthening the spleen and nourishing qi, dispelling dampness and expelling wind, eliminating Spot itching effect. In the remission period of AD, it can fundamentally adjust the patient’s spleen deficiency constitution and sensitive state, reduce the recurrence of AD, and alleviate the condition of AD recurrence. The joint application has obvious advantages in the chronic disease management of AD. Based on the sensitivity of clinical efficacy, through network pharmacology, GO function and KEGG pathway enrichment analysis, we found that compound ginseng decoction can be taken internally to regulate the CAMP signaling pathway, inflammatory mediators regulation of TRP channel, FcεRI signaling pathway and other signaling pathways, which could effectively alleviating symptoms of AD and inhibiting disease recurrence.

Compared with previous studies, this study is a retrospective analysis of authenticity, and the safety of the study drug is high with no obvious side effects. Therefore, the results of the study are beneficial to AD patients, particularly children. In this retrospective analysis of the management of AD chronic disease, compared with the control group, the recurrence rate of the research group was lower. Also, the number of recurrences and the duration of recurrence were significantly lower than those in the control group, and the time of first recurrence was significantly delayed. The difference between the two groups was statistically significant. after the intervention, patients experienced reduced severity of relapse, pruritus, and quality of life scores. According to this analysis, the combined application of compound ginseng cicada decoction in the management of chronic diseases of spleen deficiency and moist atopic dermatitis has a definite efficacy with safety and effectiveness on AD recurrence. However, our results are subjective to the limited sample size and relatively short cycle. Further study is encouraged to take our results for clinical promotion to explore the possible mechanism of effective intervention, so as to help the development of TCM preparations with inheritance characteristics in skin diseases.